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Wellbeing and its determinantsCSP Congress 2009Liverpool16
October 2009
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Social circumstances and health
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20th century trends in life expectancy in Scotland and 16 other
Western European countriesMales
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Health InequalitiesAre they due to:Poverty?Diet ?Tobacco?
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Deprivation in 1981
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Deprivation in 1991
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Deprivation in 2001
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Excess Standardised Mortality not explained by
deprivation(Scotland v. E&W)
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Coronary heart disease mortalityMen aged 15-74
yearsAge-standardised mortality per 100,000
-
World Health Organization (1997 and 2003) www.heartstats.org
Chart1
4523
3518
3234
3018
3030
2931
2921
2832
2826
2719
2637
2627
2617
2524
2432
2323
2325
2324
2222
2225
2128
2021
2027
1826
1721
1712
1717
1623
1627
1513
1414
1119
Boys
Girls
% regular smokers
Prevalence of smoking by country, in 15 year olds by sex,
2000/01, Europe
ES Fig 4.3 web05
Notes:"Smoking" defined as smoking at least once a week.
Sources:World Health Organization (1997) Smoking drinking and
drug taking in the European Region. WHO: Copenhagen;
World Health Organization (2003) Young people's health in
context. Health Behaviour in School-aged Children (HBSC) study:
international report from the 2001/02 survey. WHO:
Copenhagen.www.heartstats.org
ES Fig 4.3 web05
4523
3518
3234
3018
3030
2931
2921
2832
2826
2719
2637
2627
2617
2524
2432
2323
2325
2324
2222
2225
2128
2021
2027
1826
1721
1712
1717
1623
1627
1513
1414
1119
Boys
Girls
% regular smokers
Prevalence of smoking by country, in 15 year olds by sex,
2000/01, Europe
data
Table 4.4 Prevalence of smoking, 15 year olds, 1989/90, 1993/94
and 2000/01
%%
BoysGirls
Ukraine4523
Lithuania3518
Germany3234
Estonia3018
Slovenia3030
Czech Republic2931
Latvia2921
Finland2832
Hungary2826
Russian Federation2719
Austria2637
France2627
Poland2617
Switzerland2524
Spain2432
Belgium - Flemish speaking2323
Croatia2325
Netherlands2324
Belgium - French speaking2222
Italy2225
United Kingdom - England2128
Ireland2021
Norway2027
Portugal1826
Denmark1721
Israel1712
Malta1717
United Kingdom - Scotland1623
United Kingdom - Wales1627
Macedonia, FYR1513
Greece1414
Sweden1119
BoysGirls
Austria2637
Germany3234
Finland2832
Spain2432
Czech Republic2931
Slovenia3030
United Kingdom - England2128
France2627
Norway2027
United Kingdom - Wales1627
Hungary2826
Portugal1826
Croatia2325
Italy2225
Switzerland2524
Netherlands2324
Ukraine4523
Belgium - Flemish speaking2323
United Kingdom - Scotland1623
Belgium - French speaking2222
Latvia2921
Ireland2021
Denmark1721
Russian Federation2719
Sweden1119
Lithuania3518
Estonia3018
Poland2617
Malta1717
Greece1414
Macedonia, FYR1513
Israel1712
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Smoking prevalence - EuropeMales
-
Smoking prevalence - EuropeFemales
-
Comparison of lung cancer mortality in West of Scotland and 3
major cohortsWest of ScotlandUK doctorsAmerican Cancer Society
volunteers US veteransAverage annualdeath rate /100,000
-
020406080100never1-1415-2425+daily cigarette consumptionRate per
10,000manualnon-manual
-
Risk of death - by level of hopelessnessRHREverson et al
1996
-
Carotid artery thickening
-
00-046
-1.2
-1
-0.8
-0.6
-0.4
-0.2
0
10
20
30
40
50
Months of Orphanage Rearing
Log10 Salivary Cortisol
*linear trendline
Evening Cortisol Levels Increase with
Months of Orphanage Rearing *
The Founders Network
-
Aaron Antonovsky 1923-1994
-
.....expresses the extent to which one has a feeling of
confidence that the stimuli deriving from one's internal and
external environments in the course of living are structured,
predictable and explicable, that one has the internal resources to
meet the demands posed by these stimuli and, finally, that these
demands are seen as challenges, worthy of investment and
engagement."Sense of coherence....
-
For the creation of health........the social and physical
environment must be:ComprehensibleManageableMeaningful
-
STRESS AND GRADE OF EMPLOYMENT: MENSalivary CortisolTime of
DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470
-
Environmental determinants of inflammatory status CRP (median)
mg/dlaffluentdeprived
- P
-
Inflammation in plaquesInflammatory cells
MMPs, IL-6, IL-15, IL-18, CRPLumenCoreCapThin Fibrous
CapInflammatoryCellsSMC
apoptosisDegradedmatrixUnstablecytokinesMMP
-
01234500.511.522.533.544.55Q1 : 4.18 mg/lYears in study%
diabeticCRP and cumulative risk of type 2 diabetesFreeman et al.
Diabetes 2002,51;1596
-
Adipocyte programming insulin resistance, inflammation and
ALPAdipose storesNEFAsliverCRPSAAIL-6/IL-6sRTNF-a/ TNF-a
sR-ItriglycerideLow HDLsmall
LDLAtherogenicLipoproteinPhenotypePro-inflammatorystate
skeletal muscleInsulin resistance
-
Its all about the brain
-
All shapes and sizes!
-
Attachment theoryInfants develop the attachment behaviours that
optimally enhance their survival in their own characteristic
environments.Crittenden, 2000
-
Attachment theoryAinsworthDeep emotional connection that infant
develops with primary caregiverReflects an internal working
modelexpressing the infants expectations of parental behaviour in
meaningful situationsBasis for development of later
relationshipsIncreasingly recognised as determinant of later
emotional, cognitive and social outcomes
-
Serve and returnThe instruction to attend to the primary
caregiver is genetic, the outcome depends on what happensBalbernie,
2001
-
Engaged to respond to dangerDisengaged...Who needs to bother
about differential calculus?
-
The Dunedin cohort1000 children recruited in late 1972/3At age
3, at risk children identified on the basis of chaotic
circumstances, emotional behaviour, negativity and poor
attentivenessAs adults, those at risk were more likely to :be
unemployedhave criminal convictions (especially for violence) been
pregnant as a teenagerhave a substance abuse problemexhibit signs
of insulin resistance and metabolic syndrome
-
Telomeres
Ends of chromosomesSense and signal damageHome of repair
systemsIntegrate energy production and
utilisationAnti-cancerTelomere length predictive for mortality
-
Telomere length in twins by occupation
-
Physical activity or sweaty exercise?Are we being too modest in
our aspirations for fitness?Should we make more use of sport as a
means to get people active?By embracing physical activity, are we
admitting defeat?
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Opportunity to escape poverty, decent housing, social networks,
self esteem and sense of control
Consistent parenting, safe, nurturing early years, supportive
educationHealth related behaviours
-
Opportunity to escape poverty, decent housing, social networks,
self esteem and sense of control
Consistent parenting, safe, nurturing early years, supportive
educationHealth related
behavioursComprehensibleManageableMeaningful
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